Research Article - (2011) Volume 2, Issue 7
Malaria is a life-threatening disease caused by the parasite. It could be a major public health problem in Pakistan due to poor hygienic conditions; malnutrition borne non-defensive immunity system. The purpose of study was to examine possible changes in electrolytes level of patients with malaria. Serum electrolytes were determined by using appropriate techniques. The result showed a significant elevation in the levels of sodium (Na) and potassium (K), whereas, chloride decreases statistically in malarial patients compared to those of controls. The blood serum electrolyte level obtained for sodium was 135.55 ppm, potassium was 4.044 ppm, and for chloride was 10.33 ppm and those for the controls determined to be 130.88 ppm, 3.98 ppm and 104.5 ppm respectively. The concentration of serum electrolytes was in range of abnormal level which could lead our study towards the conclusion that the increased levels of sodium and potassium can be maintained by giving supplement.
Keywords: Electrolytes, Serum, Malaria, Flame photometer.
Malaria is the parasitic disease. The world health organization(world health organisation) estimates that 270 million new malaria infectionsoccur worldwide along with 110 million cases of illness and 2million deaths where 25% of childhood deaths in africa are attributedto malaria  common electrolytes that are usually measured sodium,potassium and chloride [2-4]. Sodium (Na+) is the major cation of extracellular fluid and as such plays a central role in the maintenance ofthe normal distribution of water and osmotic pressure in various fluidcompartments  potassium (K+) on the other hand is the major intracellularcation, having an average cellular concentration in tissue cellsof 150mmol/l .
In addition to water balance, these electrolytes play an importantrole in maintenance of ph, regulation of heart and muscle function,electron transfer reactions as well as serving as cofactors for enzymes disorders of water balance include Hyponatreamia, Hypernatraemia,Hypokalaemia and Hyperkalaemia, which also occur in conditionsof electrolyte disturbance, such as severe malaria infection .Kakkilaya, et al.  observed that malaria is often associated with abnormalitiesof fluid, electrolytes (Na+ and K+) and acid-base balance.These can occur in anybody but are more common in severe falciparummalaria, extremes of age and in patients with high degree of fever andvomiting .
Fifteen venous blood samples (10ml) of both the groups each frommalarial patients and control subjects were collected into sample tubeswithout the addition of anticoagulant. The blood samples were centrifugedat 1500 rpm for 20 minutes; the serum was separated and immediatelyused for the determination of the electrolytes, sodium, potassiumand chloride was analyzed using flame photometer (m-410corning).
All the chemicals and reagents obtain were of analytical grade obtainedfrom Merck.
Determination of serum potassium
The principal reaction is based on measuring; at an alkaline pH potassiumions and (tpb) form a turbid emulation, the formation of whichcan be measured quantitatively in a photometer at 578 nm. The increase of the absorbance (a) is directly proportional to the concentration ofpotassium in the sample 1000μl of reagent sodium hydroxide, tpb-na (R1) followed by reagentkalium (R2) in a 5ml sample tube containing 10μl blood serumwere mixed and allowed to stand for 10 minutes to complete the reaction.The absorbance was measured at wavelength 578-546 nm whichshowed the relationship between the content of alkaline phophataseand the absorbance of ca-mtb formation in a linear manner. The dayto-day variation is less than 3% (Figure 2).
Determination of serum sodium
The principle reaction is based on measuring at sodium magnesiumuranyl acetate. The excess of uranium was reacted with Ferrocyanideto produce a chromophore, the formation of which can be measuredquantitatively in a photometer at wavelength at 550nm. The increaseof the absorbance (a) is directly proportional to the concentration ofsodium in the sample (Figure 1).
Determination of Serum Chloride
1000μl of reagent mercuric (ii) thiocynate, mercuric (ii) chloride(r1) followed by reagent ferric (iii) nitrate nitric acid (r2) in a 5ml sampletube containing 10μl blood serum were mixed and allowed to standfor 10 minutes to complete the reaction. The absorbance was measuredat wavelength 436 nm, which showed the relationship between the contentof alkaline phophatase and the absorbance of ca-mtb formation in a linear manner. The day to day variation is less than 3% (Figure 3).
Table 1 show the blood serum levels of electrolytes in healthy control subjects and Table 2 show electrolytes levels in malarial patients.The results show significant increase in serum sodium and potassiumas compared to the control subjects, whereas, serum chloride level decreasesin malarial patients as compared to the control subjects.
|Sodium (Mg/Dl)||Potassium (Mg/Dl)||Chloride|
|Relative Standard Deviation||0.0664||0.1120||0.0265|
Table 1: Blood serum levels of healthy control subject.
|Sodium (Mg/Dl)||Potassium (Mg/Dl)||Chloride|
|Relative Standard Deviation||0.0353||0.0440||0.0408|
Table 2: Blood serum levels of malarial patients.
All Values Are Expressed As Mean ± S.D
From the above data it was observed that the electrolyte sodiumand potassium increases significantly whereas serum levels of chloridedecreases in malarial patients as compared to that in the control subjects
Malaria is the major reason of mortality and morbidity in the tropicaland sub tropical regions in the world. An estimated 300-500 millionpeople suffer from malaria every year and more than 1 million die eachyear(world health organisation).it is observed that, electrolytes sodiumand potassium increases significantly whereas, the chloride decreases inmalarial patients as compared to the control subjects. The blood serumelectrolytes determined for sodium was 135.55 ppm, for potassium was4.044 ppm, and for chloride was10.33 ppm and those for the controlsubjects determined to be 130.88 ppm, 3.98 ppm and 104.5 ppm respectively.
It is reported that urinary potassium waste and hypokalemia arecommon complications of severe malaria as well as potassium depletionbecomes evident that the correction of acidosis .
Maitland K, et al.  reported that the concentrations of sodium,potassium, and chloride during malaria were within normal range.Whereas,  reported that the malaria infection results in reducedlevels of serum sodium and potassium.
The present study shows that there are significant elevated level ofserum sodium, potassium and lower level of serum chloride. In malarial patients as compared to the controls been found. The study furthershows the importance of electrolyte metabolism management inmalarial patients to prevent electrolyte imbalance.
It is concluded that the imbalance of electrolytes can be maintainedby mandatory supplements intake. Our study suggested that alongwith electrolytes, antimalarial drugs should be prescribed which couldhelp to improve the treatment strategy during and after malaria for themaintaining of electrolyte level balance.